Risk factors for pulmonary mucormycosis in subjects with diabetes mellitus—A case‐control study

Background Factors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease (COVID‐19)‐associated mucormycosis outbreak in India, specific environmental exposures (especially cattle dung exposure) were proposed as possib...

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Published in	Mycoses Vol. 66; no. 9; pp. 787 - 794
Main Authors	Garg, Deepak, Soundappan, Kathirvel, Agarwal, Ritesh, Mukherjee, Soham, Kumar, Mahendra, Dhooria, Sahajal, Sehgal, Inderpaul Singh, Prasad, Kuruswamy Thurai, Ramachandran, Raja, Patil, Shivakumar, Aggarwal, Ashutosh Nath, Rudramurthy, Shivaprakash Mandya, Chakrabarti, Arunaloke, Muthu, Valliappan
Format	Journal Article
Language	English
Published	Germany Wiley Subscription Services, Inc 01.09.2023
Subjects	aspergillosis Cattle Coronaviruses COVID-19 cow dung Demography Diabetes Diabetes mellitus diabetic ketoacidosis Dung Environmental factors Hemoglobin Mucorales Mucormycosis Rhizopus Risk factors zygomycosis zygomycosis Mucorales diabetic ketoacidosis cow dung Rhizopus aspergillosis
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ISSN	0933-7407 1439-0507 1439-0507
DOI	10.1111/myc.13604

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Abstract	Background Factors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease (COVID‐19)‐associated mucormycosis outbreak in India, specific environmental exposures (especially cattle dung exposure) were proposed as possible aetiology. We hypothesized that environmental factors are associated with PM. We compared subjects with DM with (cases) and without PM (controls). Methods In this case‐control study, for each PM case, we included five unmatched diabetic controls (hospital [n = 2], community [n = 3]) without PM. We collected information on demography, COVID‐19 infection, glycated haemoglobin% (HbA1c), the type of house (pucca vs. kutcha) where the participants reside, and other environmental factors. The primary exposure tested was cattle dung exposure (CDE; using cattle dung cakes as fuel or cattle handling). We performed a multivariate logistic regression to explore factors associated with PM and report the association as an adjusted odds ratio (OR) with 95% confidence intervals (CI). Results We enrolled 39 PM cases and 199 controls (hospital [n = 80], community [n = 119]). CDE (OR 0.68, 95% CI [0.14‐3.31]; p = 0.63) was not associated with increased PM in DM. We found male sex (OR 4.07, 95% CI [1.16‐14.31]), higher HbA1c (OR 1.51, 95% CI [1.18‐16.32]), COVID‐19 (OR 28.25, 95% CI [7.02‐113.6]) and residence at kutcha house (OR 4.84, 95% CI [1.33‐17.52]) associated with PM. Conclusion Cattle dung exposure was not associated with PM in subjects with DM. Instead, male sex, poor glycaemic control, COVID‐19 and the type of housing were associated with pulmonary mucormycosis.
AbstractList	Background Factors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease (COVID‐19)‐associated mucormycosis outbreak in India, specific environmental exposures (especially cattle dung exposure) were proposed as possible aetiology. We hypothesized that environmental factors are associated with PM. We compared subjects with DM with (cases) and without PM (controls). Methods In this case‐control study, for each PM case, we included five unmatched diabetic controls (hospital [n = 2], community [n = 3]) without PM. We collected information on demography, COVID‐19 infection, glycated haemoglobin% (HbA1c), the type of house (pucca vs. kutcha) where the participants reside, and other environmental factors. The primary exposure tested was cattle dung exposure (CDE; using cattle dung cakes as fuel or cattle handling). We performed a multivariate logistic regression to explore factors associated with PM and report the association as an adjusted odds ratio (OR) with 95% confidence intervals (CI). Results We enrolled 39 PM cases and 199 controls (hospital [n = 80], community [n = 119]). CDE (OR 0.68, 95% CI [0.14‐3.31]; p = 0.63) was not associated with increased PM in DM. We found male sex (OR 4.07, 95% CI [1.16‐14.31]), higher HbA1c (OR 1.51, 95% CI [1.18‐16.32]), COVID‐19 (OR 28.25, 95% CI [7.02‐113.6]) and residence at kutcha house (OR 4.84, 95% CI [1.33‐17.52]) associated with PM. Conclusion Cattle dung exposure was not associated with PM in subjects with DM. Instead, male sex, poor glycaemic control, COVID‐19 and the type of housing were associated with pulmonary mucormycosis. Factors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease (COVID-19)-associated mucormycosis outbreak in India, specific environmental exposures (especially cattle dung exposure) were proposed as possible aetiology. We hypothesized that environmental factors are associated with PM. We compared subjects with DM with (cases) and without PM (controls).BACKGROUNDFactors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease (COVID-19)-associated mucormycosis outbreak in India, specific environmental exposures (especially cattle dung exposure) were proposed as possible aetiology. We hypothesized that environmental factors are associated with PM. We compared subjects with DM with (cases) and without PM (controls).In this case-control study, for each PM case, we included five unmatched diabetic controls (hospital [n = 2], community [n = 3]) without PM. We collected information on demography, COVID-19 infection, glycated haemoglobin% (HbA1c), the type of house (pucca vs. kutcha) where the participants reside, and other environmental factors. The primary exposure tested was cattle dung exposure (CDE; using cattle dung cakes as fuel or cattle handling). We performed a multivariate logistic regression to explore factors associated with PM and report the association as an adjusted odds ratio (OR) with 95% confidence intervals (CI).METHODSIn this case-control study, for each PM case, we included five unmatched diabetic controls (hospital [n = 2], community [n = 3]) without PM. We collected information on demography, COVID-19 infection, glycated haemoglobin% (HbA1c), the type of house (pucca vs. kutcha) where the participants reside, and other environmental factors. The primary exposure tested was cattle dung exposure (CDE; using cattle dung cakes as fuel or cattle handling). We performed a multivariate logistic regression to explore factors associated with PM and report the association as an adjusted odds ratio (OR) with 95% confidence intervals (CI).We enrolled 39 PM cases and 199 controls (hospital [n = 80], community [n = 119]). CDE (OR 0.68, 95% CI [0.14-3.31]; p = 0.63) was not associated with increased PM in DM. We found male sex (OR 4.07, 95% CI [1.16-14.31]), higher HbA1c (OR 1.51, 95% CI [1.18-16.32]), COVID-19 (OR 28.25, 95% CI [7.02-113.6]) and residence at kutcha house (OR 4.84, 95% CI [1.33-17.52]) associated with PM.RESULTSWe enrolled 39 PM cases and 199 controls (hospital [n = 80], community [n = 119]). CDE (OR 0.68, 95% CI [0.14-3.31]; p = 0.63) was not associated with increased PM in DM. We found male sex (OR 4.07, 95% CI [1.16-14.31]), higher HbA1c (OR 1.51, 95% CI [1.18-16.32]), COVID-19 (OR 28.25, 95% CI [7.02-113.6]) and residence at kutcha house (OR 4.84, 95% CI [1.33-17.52]) associated with PM.Cattle dung exposure was not associated with PM in subjects with DM. Instead, male sex, poor glycaemic control, COVID-19 and the type of housing were associated with pulmonary mucormycosis.CONCLUSIONCattle dung exposure was not associated with PM in subjects with DM. Instead, male sex, poor glycaemic control, COVID-19 and the type of housing were associated with pulmonary mucormycosis. Factors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease (COVID-19)-associated mucormycosis outbreak in India, specific environmental exposures (especially cattle dung exposure) were proposed as possible aetiology. We hypothesized that environmental factors are associated with PM. We compared subjects with DM with (cases) and without PM (controls). In this case-control study, for each PM case, we included five unmatched diabetic controls (hospital [n = 2], community [n = 3]) without PM. We collected information on demography, COVID-19 infection, glycated haemoglobin% (HbA1c), the type of house (pucca vs. kutcha) where the participants reside, and other environmental factors. The primary exposure tested was cattle dung exposure (CDE; using cattle dung cakes as fuel or cattle handling). We performed a multivariate logistic regression to explore factors associated with PM and report the association as an adjusted odds ratio (OR) with 95% confidence intervals (CI). We enrolled 39 PM cases and 199 controls (hospital [n = 80], community [n = 119]). CDE (OR 0.68, 95% CI [0.14-3.31]; p = 0.63) was not associated with increased PM in DM. We found male sex (OR 4.07, 95% CI [1.16-14.31]), higher HbA1c (OR 1.51, 95% CI [1.18-16.32]), COVID-19 (OR 28.25, 95% CI [7.02-113.6]) and residence at kutcha house (OR 4.84, 95% CI [1.33-17.52]) associated with PM. Cattle dung exposure was not associated with PM in subjects with DM. Instead, male sex, poor glycaemic control, COVID-19 and the type of housing were associated with pulmonary mucormycosis. BackgroundFactors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease (COVID‐19)‐associated mucormycosis outbreak in India, specific environmental exposures (especially cattle dung exposure) were proposed as possible aetiology. We hypothesized that environmental factors are associated with PM. We compared subjects with DM with (cases) and without PM (controls).MethodsIn this case‐control study, for each PM case, we included five unmatched diabetic controls (hospital [n = 2], community [n = 3]) without PM. We collected information on demography, COVID‐19 infection, glycated haemoglobin% (HbA1c), the type of house (pucca vs. kutcha) where the participants reside, and other environmental factors. The primary exposure tested was cattle dung exposure (CDE; using cattle dung cakes as fuel or cattle handling). We performed a multivariate logistic regression to explore factors associated with PM and report the association as an adjusted odds ratio (OR) with 95% confidence intervals (CI).ResultsWe enrolled 39 PM cases and 199 controls (hospital [n = 80], community [n = 119]). CDE (OR 0.68, 95% CI [0.14‐3.31]; p = 0.63) was not associated with increased PM in DM. We found male sex (OR 4.07, 95% CI [1.16‐14.31]), higher HbA1c (OR 1.51, 95% CI [1.18‐16.32]), COVID‐19 (OR 28.25, 95% CI [7.02‐113.6]) and residence at kutcha house (OR 4.84, 95% CI [1.33‐17.52]) associated with PM.ConclusionCattle dung exposure was not associated with PM in subjects with DM. Instead, male sex, poor glycaemic control, COVID‐19 and the type of housing were associated with pulmonary mucormycosis.
Author	Dhooria, Sahajal Soundappan, Kathirvel Chakrabarti, Arunaloke Muthu, Valliappan Agarwal, Ritesh Kumar, Mahendra Sehgal, Inderpaul Singh Rudramurthy, Shivaprakash Mandya Aggarwal, Ashutosh Nath Patil, Shivakumar Garg, Deepak Prasad, Kuruswamy Thurai Ramachandran, Raja Mukherjee, Soham
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Keywords	zygomycosis Mucorales diabetic ketoacidosis cow dung Rhizopus aspergillosis
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Snippet	Background Factors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease... Factors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease... BackgroundFactors associated with pulmonary mucormycosis (PM) among subjects with diabetes mellitus (DM) remain unclear. Following the coronavirus disease...
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SubjectTerms	aspergillosis Cattle Coronaviruses COVID-19 cow dung Demography Diabetes Diabetes mellitus diabetic ketoacidosis Dung Environmental factors Hemoglobin Mucorales Mucormycosis Rhizopus Risk factors zygomycosis
Title	Risk factors for pulmonary mucormycosis in subjects with diabetes mellitus—A case‐control study
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